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HomeMy WebLinkAbout3532-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located atl~.$~?.~.e~.. A?.$ ............. Street ~ .Fairviev Pa~k . . .......... ap ~o ........... ]~roc~: No ............. Lot No.l~l ....~BI...~.~..1.~.~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~T~lla.. ~. ..... , 19.67. l~Ursuant to which Building Permit No.. dated ......... J~ill~ .... ~1)- -, 19.6?', was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pl'~,~&tll..olle. ~i~. &~l,:l.:J~g ..................................... The certificate is issued to . .,T.~.e.~ ~ ~l~ffO~ .... ~Nl~e~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . $~l~t. I~.~ .1~...1~..I~. Building Inspector J FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPAitTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3532 Z Dete .......................... ~.....,~.0. .......... , 19...0~ Permission is hereby granted to: ...... i.. ....... ~...$.~ ............................................... .............. ~.;....~u,t,,haZ~. ....................................... to '. ~,.~,.:~r~l~ ..~;. ,~.~,~ ....~W~L~ ~ ............................................................. ., .................... ...... ;.....~ ............ : .......... .,. ......... ;...~;..~ ........................................................................... ~ ...... ~ ..................... at premises located ,~t ...T~.~.**,l,~.****;l~;[~le~..~.~.'k .................... : ......................... ~ ....................... .. i.......,....]~t.~ ..(~lee~,~'a~.'.~ze...'. ...... ;. ~t~o;IA. ........................................................................ ~ursuon~' to application doted. ....... :. ............... ~T~,~....,~,~ ................. , 19~f",, and'approved by the Building InsPector, .~ . Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH ~ld~. Permit No. c7~-J~.7- TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) / have been inspected by this department and found to be satisfactory. ./r~.~'-?~ ~-o'7 TOWN OF SOUTHOLD PROPERTY RECORD CARD )WNER STREET VILLAGE DIST. SUB, LOT :ORMER O,WNER ,Krl ob~ k N E ! ' ~.~/~ !SEAS. VL ~ FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS " / ¢ u' :ARM X~re Value Per V~lue ' ¢)Y~r ~'~ ' liable 3 'oodland ¢ampland FRONTAGE ON WATER ushlond FRONTAGE ON ROAD ~use Plot DEPTH ~ ~ ~ ~ BULKH~D ~ / ~ DOCK ~tal ~' '~ ~ , , . COLOR TRI,M Extension Extension Extension ),~mdation Basement Ext. Walls Fire Place Bath Floors Interior Finish Heat Type Roof Rooms 1st Floor Porch Recreation Roorr Rooms 2nd FIoo t~h'~J),eJ(, /~4/'22. ~7~ .2--( ~c~,, Dormer Breezeway Driveway Garage Total Dinette ¸LR. i DR. FiN. B. FOBM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E om, ed ....:.:,. ............. Approved ......~:.~ ........................ .~.~....., 19 ........ Permit No. D,sopproved..- ........ ........... , .............. ('~';,';i;i;;,'~"i;;~;;';;>i ................................. Application No. ''~ ..... APPLICATION FOR BUILDIN,G.?ERMIT ~ot~--: t...~:: ~.:.~... ~:.. './.. ...................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to ad oining premi.ses or public streets or areas, and giving o detailed description of ayout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shah be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of So~thold, Suffolk County, New YQrk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or emolition, as herein described. The applicant agrees to comply with all applicable laws, building code and or name, if a corporation) State whether applicant i~s owner,,lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ~; z.~ /:2 /.~.:: ,~ame or owner o p ::7 ................. ,'. ............. : ...... :? ............, .............................................................................. ' ~ r tf applic~6 a corporo~, s~gnotufe of duly~outhonzed office . (~ome ~nd titlo of corporote -.~/ ~ /~ 1. Location of and on wh ch proposed work wi l be done M~p No ~~~</~t No' - 'e '":,Z .......................... Street and INureD r .... (..w~~ ..... ':,,.,,% ................ ~ .......... ~ ........................................ Municipality 2. State existing use and occupancy of premis~z//~ ~and intended,use and occupancy of proposed construction: a ~x,,~se~.do~p~c, ~*::~.~.~ . . ............................. b. Intended use and occupancy ....... ~:f~ ................................................................................... 3. Not, ire of work (check which applicable): New Building Y Addition Alteration Rep~ lir .................. Remo_~.al .......... ~ Demolition ................ .~t~er Work (Describe) 4. Estir~area k. ost ............................................................ tee (to be paid on filing this application) 5. If d~velling, number of dwelling units ...... ~....Number of dwelling units on each floor If go, rage, number of cars ........... '. 1 6. If I:jusiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Frbnt ............................ Rear ................................ Depth Hei~lht ........................ Number of Stories Dim,bnsions of same structure with a.lterations or additions: Front .................................... Rear Depth ................................ Height ...................... .~...,~umber of Stories ................................ 8. Dim~ens~n~ofj ~ entire new construction: Front~ 'k.-4c..~'""~"'""d~'" ...................... Rear ..~......~... ................ Depth~..~, .............. He ~ht ............... .7~::~:~ber of Star,es 9. SizeJof. lot: Front ....... 7~.,~.~:'...~... Rear ....~.....d~'....~.. ...................... Depth 10. Dat~ of Purchase ..................(. .................................. ~:.j~_N~.~e~f Former Owner 1 ]. Zon~b or use district in which premises are situated ........................................ ~.~. ............. n I i 12. Dae~ proposed construction, violate any .~on'~j~wlaw,~rdina ce or rec~u at'on .................... -- . . ~;~'~'~' (:~Z-7~_d' . ,, /~ 13. Na~e of Owner at pre ~r~.~ses ................. ,~,,~c ........ r. ....... ~aaress ........ ~....~ ............................. Phone No. NaCe of.-Architect. ...~'-/,' ....... -~'.'" "~:'~' "/-'; ' '~)C.~.-~,r,-'~ ~z,/~/~.~ ........... -,,Address ~~ ............ Phone No. Nar~e of ~.onTracror .................................................... ,'~aaress ............................................ Phone No. / PLOT DIAGRAM / L.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines.'~' Give street and block number or description according to deed, and show street names and whether nterior or corner lot. STATE OF~ NEW YORK, 'L c c ~ ................. [.....~.~'.?.! .......................... being duly sworn, deposes end says th.o¢ he is the I'(Name of individual signing application) above nar~ed. He is the / (Contractor, agent, corporate officer, etc.) of said ortner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his and belief; that the w )rk will be performed in the manner set forth Jn the application filed therewith. Sworn to b .~fore me this · I~AR[ A. T ' ........ ..... day of ........ ...... : ,~"%,~ -, !~' /'"- ,L,,,J ,l~o. 5.2.3233120 Suffo.lJ~.~.u.n~ ...................................... .~ Notary Pt )lic, ~.~'.[~.....~.~...~x~irEc~frr~y~]0' ~ (Signature of applicant) FOI~M NO. 1 '['OWN OF SOUTHOI~D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDI~G~PERMIT T te~ ~!~'" ' '~' / ~*~' ' '~' 2~' ' ........................... ' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordina,~es, building code and~gulations./z (Sig~4ature of appJicagt, or name if a corporation) ..... ........................ State whether applicant is ownm agent, architect, engi.neer, general contractor, electrician, plumber or builder. Name of owner of premises If applic a gna of dul~ officer. ..... (Name and title of corporate officer) Location of land on which prol)~sed work w be done Map N :~.~.~.?.'?'?'?'?'?'?'?'~.~..~':.~..,~ot No' ./..~- . ....................... Street and Number ,,.~,~ ......................................... .~,....~-,,,,,r,.,,... ........................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Ex~stmg use and occupancy ..........................~¢ ................................................................................................ b. Intended use and occupancy / 3. NatJ~re of work (check which applicable): New Building .... ~¢~........... Addition .................. Alteration RepgJr .................. Removal .................. Demolition .................. Other Work (Describe) (to be paid on filing this application) 5. If cwelling, number of dwelling units ....... ~..~(~,...Number of dwelling units on each floor If garage, number of cars r 6. if I~usiness, commercial or mixed occupancy,,' specify nature and extent of each type of use 7. Din ensions of existing structures, if any: Front ............................ Rear ................................ Depth Hei ht ........................ Number of Stories Dir~ensions of same structure with alterations or additions: Front .................................... Rear De~c th ................................ Height ............................ Number of Stories ................................ 8. Din ensions of entire new construction: Front ..... ~.~...~.~..'. ................... Rear ...Z~...~ ................. Depth-~.(~ ........... Hei iht . ./../~.~. ........... Number of Stories 10. Dot of Purchase ...... ../.~.~..~..~.. ................................ Name of Former Owner .................... 11. Zore or use district in which/~remises are situated ...~....~C~ ............................................."."".? 12. Doe; proposed construction ~violate any zonino, law, ordinance or regulotionP .~.~ .............. PLOT DIAGRAM Locat clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions fr, property li~nes. Give street and block number or description according to deed, and show street names and indic~ whether in~enori or corner Jot. STATE OFj NEW YORK, COUNTY .OF ...... ;;~ .................... ,(Name--~~------ot inaJvidual signing application) above nar~ed. He is the j (Contractor, agent, corporate officer, etc.) of said oW.:ner or owners, and is duly authorized to perform or have performed the said work and to make o.nd this ctpplic'ation; that all statements contained in this application are true to the best of his knowledge and belief; that the w~)rk will be performed in the manner set forth in the application filed therewith. Sworn to bl~fore me this ......... .~.~ ....... day of duly sworn, deposes and says that he is the applic Notary P~ (Signature applicant)